 |
| Click for Quote and to Enroll |
|
|
| Click on the NASC Logo Above to Access Application Site |
|
|
|
An International Medical Insurance Plan for Individuals and Families |
|
Please review both plans of insurance as well as the information on the company and processes prior to applying. Your cost for this insurance is dependent upon many variables pertaining to you such as sex, age, current medical condition, medical history, etc. Depending upon your current health and expected use of this insurance, one plan will meet your specific needs better than the other. If you have any questions, please call Jeff Curry at 412.298.1938 for a consultation.
|
|
Economy
Less expensive plan due to dollar limits on the maximum paid for any covered service. If providers charge exceeds the maximum amount the balance due is the responsibility of the insured.
|
|
Major Medical
More Expensive because this Policy pays for care at the provider rate up to policy maximums for all covered care. Insured pays deductible amount first. Polcy pays 80% of next $5,000 if provider is not in Insured PPO Network. If in the PPO Network, the 20% co-insurance cost to the insured may be waived.
|
Recommended Format
$500 Deductible - This means the first $500 in medical expenses will be paid by you before the insurance pays anything. Only one deductible is charged during the policy period. The higher the deductible, the lower the cost of the insurance. There is also a $250 deductible which will price the highest.
Add Sports Rider - Provides $5,000 in medical coverage for contact sports related injury occurred during activity not for wage, reward, or profit.
Pay Monthly
|
| Major Medical Insurance Benefits |
Medical Coverage
| BENEFIT |
Limit - all limits are per Certificate Period except as specifically indicated otherwise |
| Overall Maximum Limit |
$5,000,000 Lifetime |
| Coverage Area |
Option 1 - Including the US and Canada
Option 2 - Excluding the US and Canada |
| Deductibles Available |
$250, $500, $1,000, $2,500 or $5,000 per Member per Certificate Period |
| Family Deductible |
Maximum of 3 Deductibles per Family per Certificate Period |
| Coinsurance -- Claims Incurred in US or Canada* |
After the Deductible, Underwriters will pay 80% of the next $5,000 of Eligible Expenses per Member per Certificate Period, then 100% to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider |
| Coinsurance -- Claims Incurred outside US or Canada |
After the Deductible, Underwriters will pay 100% of Eligible Expenses per Member per Certificate Period to the Overall Maximum Limit |
| Family Coinsurance |
After $3,000 of Coinsurance has been paid per Family per Certificate Period, Underwriters will pay 100% of Eligible Expenses to the Overall Maximum Limit |
| Hospital Room and Board -- In US or Canada* |
Average Semi-private room rate |
| Hospital Room and Board -- Outside US or Canada |
Average Private room rate |
| Intensive Care Unit |
Usual, Reasonable and Customary |
| Prescription Drugs |
Usual, Reasonable and Customary Subject to Deductible and Coinsurance |
| Mental Health Disorders |
$10,000 per Certificate Period, $25,000 Lifetime Maximum, $50 Maximum per visit per day for outpatient care (after 12 months of continuous coverage) |
| Maternity -- Normal or Complicated Delivery |
After the Deductible, Underwriters will pay 50% of the next $100,000 of Eligible Medical Expenses, then 100% to a Lifetime Maximum of $250,000. Covered Maternity expenses include pre-natal, Delivery, and post-natal care (after 12 months of continuous coverage) |
| Maternity -- Complicated Delivery |
After the Deductible, Underwriters will pay 50% of the next $100,000 of Eligible Medical Expenses, then 100% to a Lifetime Maximum of $250,000. Covered Maternity expenses include pre-natal, Delivery, and post-natal care (after 12 months of continuous coverage) |
| Maximum for Maternity |
$250,000 Lifetime |
| Newborn Care |
Included as part of Maternity benefits for a maximum of 60 days |
| Pre-existing Conditions |
Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider |
| Local Ambulance |
Usual, Reasonable and Customary |
| Physical Therapy |
$50 Maximum per visit per day |
| Wellness |
All Wellness benefits are available after 12 months of continuous coverage and are not subject to Deductible. Members under age 19: $50 per visit (including immunizations), maximum of three visits per Certificate Period. Members age 30 and over: $250 per Member per Certificate Period. Female Members age 40 and over (or qualifying Woman at Risk): $100 per Member per Certificate Period for a screening mammogram |
| Human Organ/Tissue Transplants |
Same as any other Illness for Covered Transplants** |
| All Other Eligible Expenses |
Usual, Reasonable and Customary |
| Emergency Medical Evacuation |
$50,000 Lifetime Maximum |
| Repatriation of Remains |
$25,000 Limit |
| Emergency Reunion |
$10,000 Lifetime Maximum |
| Pre-certification Penalty |
50% |
* Benefits within the US and Canada are not available to applicants electing Option 2 as their Coverage Area.
**Covered Transplants include Heart/Lung, Lung, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow. |
Optional Sports Rider
| Sports Category |
Lifetime Maximum |
| Extreme Sports |
$25,000 |
| Contact Sports |
$5,000 |
|
| Click on the NASC Logo at the Top of the Page to Apply |
| Economy Plan Scheduled Benefits |
Benefits and Limits
| Benefits |
Limits |
| Coverage Area |
Worldwide |
| Overall Maximum Limit |
$5,000,000 Lifetime |
| Deductibles Available |
$250, $500, $1,000, $2,500 or $5,000 per person per Certificate Period |
| Coinsurance -- Claims Incurred in US or Canada |
After the Deductible, Underwriters will pay 80% (20% Coinsurance paid by insured) of the next $5,000 of Eligible Medical Expenses per Member per Certificate Period, then 100% to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider |
| Coinsurance -- Claims Incurred outside US or Canada |
After the Deductible, Underwriters will pay 100% of Eligible Medical Expenses per Member per Certificate Period to the Overall Maximum Limit |
| Acute Onset of Pre-existing Condition |
$1,000 during the first Certificate Period and $2,500 during the second Certificate Period |
| Pre-existing Conditions |
$5,000 per Certificate Period subject to a Lifetime Maximum of $50,000 (including Acute Onset claims) after 24 months of continuous coverage under the plan |
| Maternity |
$5,000 per Pregnancy after 12 months of continuous coverage under the plan, including Inpatient, Outpatient and other benefits provided under the plan. Not subject to Coinsurance |
| Newborn care |
$15,000 per covered Pregnancy, including Inpatient, Outpatient and other benefits as provided under the plan, during the first 60 days of life |
| Organ Transplants |
$250,000 Lifetime maximum for Covered Transplants* |
| INPATIENT BENEFITS (All Subject to Deductible and Coinsurance) |
| Hospital Room and Board |
$600 per day, maximum of 240 days per Hospitalization (including ICU days) |
| Intensive Care Unit (ICU) |
$1,500 per day, maximum of 240 days per Hospitalization (including non ICU days) |
| Lab, x-rays and other covered Inpatient services & supplies |
Usual, Reasonable and Customary Charges (except as limited under the plan) |
| OUTPATIENT BENEFITS (All Subject to Deductible and Coinsurance) |
| Office Visits (Including Physician, Specialist Physical, Psychiatrist, Chiropractor, Surgical Consultant, Physical or Occupational Therapist) |
25 visits per Certificate Period per person as provided under the plan |
| Physician |
$70 per visit |
| Specialist Physician |
$70 per visit |
| Psychiatrist |
$60 per visit, after 12 months of continuous coverage under the plan |
| Chiropractors |
$50 per visit (must be prescribed by another non-Chiropractor Physician) |
| Surgical Consultant |
$500 per consultation prior to Surgery |
| Physical or Occupational Therapy |
$50 per visit (must be prescribed by a Physician who is not affiliated with the Physical Therapy practice) |
| X-rays |
$250 per exam (includes Sonograms, Ultrasounds and diagnostic Mammograms) |
| Laboratory |
$300 per exam (includes all procedures carried out on one specimen) |
| Emergency Room |
Usual, Reasonable and Customary for covered Illnesses if hospitalized as Inpatient and for covered Injuries |
| Local Ambulance |
$1,500 per Certificate Period per person |
| INPATIENT or OUTPATIENT BENEFITS (All Subject to Deductible and Coinsurance) |
| Prescription Medications |
Usual, Reasonable and Customary |
| Surgery |
Usual, Reasonable and Customary |
| Assistant Surgeon |
20% of Surgeon benefit |
| Anesthesiologist |
20% of Surgeon benefit |
| Midwife Services |
$500 per covered Pregnancy |
| MRI, CAT Scan, Echocardiography, Endoscopy, Gastroscopy, Colonoscopy and Cystoscopy |
$600 per exam |
| Chemotherapy and Radiation Therapy |
Usual, Reasonable and Customary |
| WELLNESS BENEFITS (Not Subject to Deductible) |
| Well Child (under age 19) |
$50 per visit for a maximum of 3 visits per Certificate Period (included in Office Visit limit), after 12 months of continuous coverage under the plan |
| Wellness (Adult 19+) |
$250 per Certificate Period, after 24 months of continuous coverage under the plan, including Office Visit for $70 and X-Ray and Lab for $180 |
| OTHER BENEFITS (All Subject to Deductible and Coinsurance) |
| Durable Medical Equipment |
Usual, Reasonable and Customary charges for Wheelchair, Hospital Bed, and/or Toilet |
| Emergency Medical Evacuation |
$50,000 Per Certificate Period |
| Repatriation of Remains |
$25,000 Lifetime Maximum |
| Emergency Reunion |
$5,000 Lifetime Maximum |
*Covered Transplants include Heart, Heart/Lung, Lung, Kidney, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow.
Optional Sports Rider
| Sports Category |
Lifetime Maximum |
| Extreme Sports |
$25,000 |
| Contact Sports |
$5,000 |
|
| Click on the NASC Logo at the Top of the Page to Apply |
Who is the Plan Administrator?
HCC Medical Insurance Services (HCCMIS), headquartered in Indianapolis, Indiana, is a full service organization offering a comprehensive portfolio of insurance products designed specifically to address the insurance needs of consumers worldwide. HCCMIS is a subsidiary of HCC Insurance Holdings, Inc. (HCC), which is a leading international specialty insurance group headquartered in Houston, Texas. HCC has assets of more than $8.6 billion, shareholders' equity in excess of $2.7 billion and is rated 'AA' (Very Strong) by Standard & Poor's, 'AA' (Very Strong) by Fitch Ratings and 'A+' (Superior) by A.M. Best Company.
Who is the Insurer?
CitizenSecureSM is insured by Syndicate 4141 at Lloyd's, London. Lloyd's is the largest and oldest insurance market in the world and is rated 'A' (Excellent) by A.M. Best Company and 'A+' (Strong) by Standard & Poor's. Lloyd's provides financial strength and security that is unparalleled in the worldwide insurance market. Lloyd's is recognized as a market leader in the accident and health insurance arena and is well known for its innovative products and services. Presently, Lloyd's provides accident and health insurance to millions of individuals in almost every country of the world.
Which Coverage Area is Right for Me?
CitizenSecureSM offers two coverage areas: including the US and Canada and excluding the US and Canada. If you desire worldwide coverage, select the "Including the US and Canada" option. If you do not need or desire coverage in the US and Canada, you may obtain lower premiums by selecting the "Excluding the US and Canada" option.
Am I Eligible for CitizenSecureSM?
CitizenSecureSM is available to citizens of most countries of the world who are at least age 14 days and not over age 74. If you are a US citizen, you must reside outside the US, or be departing the US within 30 days of the effective date. If you are a US citizen, you must also reside outside the US for at least 6 months within each Certificate Period. Citizens of other countries may reside abroad, including the US or their country of citizenship. Optional Term Life Insurance is not available to residents of the US, regardless of your citizenship.
Coverage Under CitizenSecureSM Renewable?
Yes. CitizenSecureSM products are annually renewable. There are no medical questions at renewal. Renewal is subject to your continued eligibility and timely payment of premiums. Your renewal premium will be the same as all persons of the same Certificate origination year, age and gender. If you purchase coverage before you reach the age of 65, and maintain coverage continuously for 10 years, subject to continued eligibility, you will automatically be eligible to apply for the CitizenSecureSM Senior Plan with no medical questions.
CitizenSecureSM Senior Plan
Eligibility for the standard CitizenSecureSM plan ends at age 75, but for those members who joined before age 65 and have maintained coverage for at least 10 years, the CitizenSecureSM Senior Plan is available with no medical questions. The CitizenSecureSM Senior Plan offers many of the same benefits and limits as the standard CitizenSecureSM plan. The Senior Plan deductibles available are $5,000, $7,500, and $10,000. On the Senior plan, the Overall Maximum Limit is reduced to $1 million. Additionally, the Human Organ Transplant and Emergency Medical Evacuation benefits are deleted.
What Should I Expect During the Underwriting Process?
CitizenSecureSM is a medically underwritten plan, which means that your family's medical status and history will be used to determine your eligibility for coverage. When Underwriting reviews your Application, they will evaluate the medical information that you provide and determine whether coverage can be issued and if Riders are necessary. These Riders allow Underwriting to issue a Certificate by excluding coverage for specified conditions.
Additionally, your premium may be impacted by certain factors. If additional premium is due, you will be notified after a medical underwriter has reviewed the application.
Preferred Provider Network (PPO)
Coinsurance will be waived for expenses incurred in the US within our direct-pay PPO. Simply present your identification card at the provider's office so that they may contact us to verify benefits and billing information. For your convenience, HCCMIS also offers an international network. Both networks are searchable through Client Zone, which is accessible with your Certificate number and date of birth once coverage has been approved.
How Do I File a Claim?
Filing a claim is easy. Once your Application is accepted, you will receive a kit which contains Claimant's Statement and Authorization forms. Complete this Claimant's Statement and Authorization form, attach original, itemized bills, and forward them to HCCMIS. Be sure to complete your Claimant's Statement entirely and sign it. If you have already paid certain expenses, attach copies of your payment receipts. You will be reimbursed for eligible medical or dental expenses. In many cases, HCCMIS will make payments directly to the hospital or physician that treated you. Remember, you are responsible for the deductible, coinsurance, and any ineligible charges.
Pre-certification
CitizenSecureSM plans require Pre-certification, which simply means that you must contact HCCMIS as soon as possible before a planned hospitalization or surgical procedure, within 48 hours of an emergency hospital admission, or within the first 90 days of pregnancy. Pre-certification allows us to establish contact and make payment arrangements with your providers, negotiate discounts which will benefit both you and us, pre-arrange future care, and plan for your claim. Pre-certification helps us help you.
What Are the Plan Features?
Pre-existing Conditions:
If your Pre-existing Conditions have been fully disclosed on your Application and not excluded or restricted by a Rider or any other provision of your Certificate, your Pre-existing Conditions are covered the same as any other Illness or Injury as of your effective date. Pre-existing Conditions include any Injury, Illness or Mental Health Disorder that existed at or prior to your initial effective date, including chronic or recurring conditions.
What Are the Exclusions and Limitations?
The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:
- Charges not Incurred during the Certificate period
- Services or treatment payable by another insurance or government
- Substance Abuse
- Charges which exceed Usual, Reasonable and Customary
- Investigational or experimental Surgeries or treatment
- Custodial, Educational or Rehabilitative Care
- Weight modification
- Cosmetic surgery, unless reconstructive surgery is directly related to a covered Injury or Illness
- Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
- Individuals HIV+ at effective date
- Charges relating to congenital conditions
- Drugs or treatment for sexual dysfunction
- Drugs or treatment to promote or prevent conception
- Devices or procedures to correct sight or hearing
- Self-inflicted Injury or Illness
- Foot care, unless related to a covered accidental Injury
- Treatment or supplies not ordered by a Physician or not Medically Necessary, except for Wellness Benefits provided under the plan
- Organ transplants, except for Covered Transplants
- Speech, acupuncture, occupational or sleep therapy
- Acts of Terrorism, war, insurrection, riot or any variation thereof
- Dental Treatment, except emergency treatment following a covered Accident, or unless Dental Rider is purchased
The following are excluded from the Optional Dental Rider:
- Orthodontia
- Sealants, bleaching and oral hygiene expenses
This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.
Special Illness Exclusion:
The following conditions which manifest themselves within the first 180 days of coverage are excluded: Any condition of the breast, prostate, reproductive system, tonsils, adenoids, hemorrhoids, hernia, gallstones, kidney stones, glaucoma, cataracts, disk disease, varicose veins, all types of cysts, arthritis, and repetitive motion disorders, and any disorder or disease of the skin.
Wellness:
After 12 months of continuous coverage, you may be eligible for Wellness benefits that are not subject to the Deductible. If you are at least 30 years of age, you will be entitled to the following Wellness benefit: $250 per Certificate Period for a Routine Physical Exam, including OB/GYN visits for females. Additionally, females who are at least 40 years of age will be entitled to the following benefit: $100 per Certificate Period for a screening mammogram. If you are under the age of 19, you will be entitled to the following Wellness benefit: $50 per visit (including immunizations) with a maximum of three visits per Certificate Period.
Emergency Medical Evacuation:
CitizenSecureSM provides coverage for Emergency Medical Evacuation to the nearest medical facility qualified to treat your life-threatening condition or potential loss of limb. All Emergency Medical Evacuations must be approved in advance and coordinated by HCCMIS. Emergency Medical Evacuations provide you with access to care when you need it most. HCCMIS is available 24 hours a day, 7 days a week, to approve and coordinate Emergency Medical Evacuations.
Emergency Reunion:
In the event of a covered Emergency Medical Evacuation, CitizenSecureSM will provide the following benefits: the cost of an economy round-trip air and/or ground ticket for one of your Relatives (parent, spouse, sibling or child age 18 or above) for travel to the area where you are hospitalized following an Emergency Medical Evacuation and reasonable expenses for lodging and meals for your Relative for a period not to exceed 15 days.
Repatriation of Remains:
In the event of a covered Injury or Illness resulting in your death, the plan will provide the following benefit: air and/or ground transportation of bodily remains or ashes to the area of your principal residence and reasonable cost of preparation of the remains necessary for transportation.
Optional Dental Rider:
If you purchase the Optional Dental Rider, children age 9 to 16 are covered for Preventative Dental Benefits, including routine oral exams every 6 months, fluoride treatment every 12 months and bitewing x-rays every 24 months. All covered family members receive Basic and Major Dental Benefits. Basic Benefits include periodontics, endodontics, extractions and fillings. Major Benefits include crowns, bridges and dentures. The CitizenSecureSM Optional Dental Rider is useful for families as well as individuals. Coverage is provided in most countries of the world at your choice of dentists.
Optional Sports Rider:
The Optional Sports Rider provides additional coverage for your extreme sports lifestyle. Whether your interests include mountaineering, skydiving, or whitewater rafting, electing the Sports Rider option will add coverage up to a lifetime maximum of $25,000 for these activities excluded by the standard plan. Coverage for Contact Sports, such as soccer or hockey, is added up to a lifetime maximum of $5,000. The Sports Rider adds coverage for sports and athletics except those activities engaged in for wage, reward, or profit.
Optional Term Life and AD&D Insurance:
If you reside outside the US, you may be able to purchase the Optional Term Life and Accidental Death and Dismemberment insurance to protect your family and provide cash benefits in the event of your death. The amount of coverage under Option 1 ranges from $5,000 to $50,000, depending on your age at the time of your death or dismemberment. If you are at least 19, but not yet 65, you may purchase Option 2 coverage, which doubles the benefits available to you.
CitizenSecureSM Assistance Services:
Assistance Services are available to you 24 hours a day, 7 days a week while your CitizenSecureSM plan is in effect.
Pre-Trip Health and Safety Advisories (available after your purchase of CitizenSecureSM and before your departure) - Call us for current passport, visa, inoculation and vaccine requirements, as well as up-to-date travel safety advisories.
LiveTravel Services® - We will make emergency travel and itinerary changes for you including rebooking flights, hotel reservations and ground transportation arrangements.
BagTrak® - We are one of the industry leaders in tracking lost checked baggage. We will help you locate your lost checked baggage and deliver it to you.
Emergency Message Relay - We will relay messages to your family, friends and co-workers, helping you to maintain contact during an emergency.
Emergency Cash Transfers - We will assist you in arranging and obtaining cash transfers in various countries around the world.
CitizenSecureSM Assistance Services also include:
- Medical referrals
- Up-to-the-minute travel medical advisories
- Assistance with prescription drug replacement
- Dispatch of a doctor or specialist
- Emergency travel arrangements for family members
- Lost passport or travel documents assistance
- Embassy and consulate referrals
- Legal and accounting referrals
- Bail bond assistance
- Translation and interpretation assistance
CitizenSecureSM Assistance Services are not insurance benefits. Any assistance service provided is not a guarantee of any insurance benefit under CitizenSecureSM
|
| Click on the NASC Logo at the Top of the Page to Apply |
|